Antibiotic-resistant gonorrhea may soon appear as 'superbug'

Faced with the continued spread of antibiotic-resistant gonorrhea in Asia and Europe, the U.S. Centers for Disease Control and Prevention repeated its warning Friday to U.S. doctors: Prepare for the arrival of the dangerous bacteria and avoid the kind of antibiotic prescription practices that breed so-called superbugs.

Gonorrhea is the second most commonly reported infectious disease in the United States, and has become resistant to all but one class of antibiotics, cephalosporins, which are becoming less effective at treating it. Some countries in Europe and Asia have already seen cephalosporin-resistant gonorrhea, and growing fears that it will make its way to U.S. shores prompted the CDC's warning to doctors in the latest issue of the public health agency's Morbidity and Mortality Weekly Report.

Barbara Johnston, MD, Associate Medical Director at Mount Sinai Comprehensive Health Program in New York, said people need to be aware that some treatment is already failing, and one day, gonorrhea may be incurable.

"There's the attitude that this disease is curable," says Barbara Johnston, MD, Associate Medical Director at Mount Sinai Comprehensive Health Program in New York. "We tell our patients that we've already had to change our treatment twice, and there may come the day where we don't have a treatment for it. I think it's just a matter of time."

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Antibiotic-resistant gonorrhea isn't the only disease that is beating drugs that were once effective. Outbreaks of multidrug-resistant tuberculosis in third world countries have put thousands of people at risk of this deadly disease. Multidrug-resistant tuberculosis does not respond to the traditional tuberculosis treatment, and instead requires other drugs that are not always available in the countries where tuberculosis is most prevalent. In addition, multidrug-resistant tuberculosis can require up to two years to treat, and can be very expensive.

While antibiotic-resistant gonorrhea and multidrug-resistant tuberculosis have not yet made their way to the United States, one antibiotic-resistant bacteria is starting to emerge here. Antibiotic-resistant urinary tract infections have started to make their appearance, and according to a report by Extending the Cure and the Robert Wood Johnson Foundation in November, could pose a serious threat.

"Without proper antibiotic treatment, UTIs can turn into bloodstream infections, which are much more serious and can be life-threatening," Ramanan Laxminarayan, director of Extending the Cure, said in a statement. "These findings are especially disturbing because there are few new antibiotics to replace the ones that are becoming less effective. New drug development needs to target the types of drug-resistant bacteria that cause these infections."

The CDC outlined the need for new treatments in its warning Friday, saying that since federal approval of new drugs takes so long, researchers should look into the new treatments now, before antibiotic-resistant gonorrhea becomes a problem in the United States. "Antimicrobial drug development is needed now," the MMWR article stated, "particularly because the development process for new drugs can take more than a decade."

Still, Steve Solomon MD, director of the CDC's office of antimicrobial resistance, says that creating new antibiotics to combat diseases may not solve the underlying problem -- the overuse of the drugs.

"The principal driver of antibiotic resistance is the use of antibiotics," Solomon says. "The more antibiotics that are used, the more the bacteria become resistant to them. Unfortunately, a significant proportion of the antibiotics used in the United States don't need to be used. Some studies suggest that a third to a half of all antibiotics given to people in the U.S. may be unnecessary or used inappropriately."

Solomon says that doctors need to become more judicious in prescribing antibiotics in order to prevent antibiotic-resistant bacteria from spreading.

"As public health authorities learn more about how, when and where antibiotics are used, we can be much more effective, working with clinicians, to improve the way antibiotics are given to patients, making sure that antibiotics are given only when necessary and are always given appropriately," he says. "Doctors, hospitals and other health professionals around the U.S. are embracing the idea of antibiotic stewardship, ensuring that these drugs are always used prudently so that their effectiveness is preserved.